Provider Demographics
NPI:1679083042
Name:GERSHONOV, ALINA
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:GERSHONOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14335 SW 120TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7296
Mailing Address - Country:US
Mailing Address - Phone:305-967-8074
Mailing Address - Fax:305-967-8302
Practice Address - Street 1:14335 SW 120TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7296
Practice Address - Country:US
Practice Address - Phone:305-967-8074
Practice Address - Fax:305-967-8302
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3151106H00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist